U.S.-Russia relations are in a deep crisis. However, the current state of these relations should not prevent the two powers from cooperating on resolving global problems. Rethinking Russia assesses six global health challenges, which can bring Moscow and Washington together.

Relations between Russia and the United States have seldom been frostier than they are today. Despite pleas for détente from elder statesmen, like former Soviet President Mikhail Gorbachev, serious disagreements between Washington and Moscow remain on major international issues, from Iran to Ukraine. Moreover, the allegations of Russian interference in the 2016 American presidential election have inhibited any major thaw in diplomatic ties.

However, recently there have also been some promising signs in relations between the two global powers. Moscow and Washington both cooperated in the successful defeat of the Islamic State in Syria and, in December, U.S. intelligence helped to foil a terrorist plot in St. Petersburg.

In an op-ed in The Moscow Times published on Jan. 26, US Ambassador to Russia Jon Huntsman emphasized that US-Russian relations “can and must improve.” These are positive steps toward improving a difficult relationship. At the same time, bold initiatives need to be taken for cooperation on major international problems.

Chief among these concerns are several challenges facing both American and Russian society in the realm of international public health. These issues require global cooperation in response, planning, prevention, preparedness, and care. Below are six of the most imminent concerns.

Bioterrorism

The use of biological weapons has an extensive history. In one of the most notorious examples in 1346, the Mongol army under the command of Janibek catapulted corpses of plague victims into the then-Genoese-held city of Kaffa (modern Feodosiya) in the Crimea.

During the Cold War, both the United States and the Soviet Union developed advanced biological weapons programs. The use of chemical weapons, such as Agent Orange, in the Vietnam War by the U.S. created an outcry from the American public. This outcry led to the end of the American bioweapons program by the Nixon administration in 1969. The Soviet bioweapons program officially ended in 1992, after the dissolution of the U.S.S.R.

More recently, the use of bioweapons in terrorist attacks, or bioterrorism, has emerged as a major public health threat. In the U.S. in 2001, letters laced with anthrax caused five deaths and raised considerable alarm in light of the September 11 terrorist attacks. For Russia, potential bioterrorism is especially concerning, given its problems with Islamic extremism in its volatile North Caucasus region, as well as the legacy of the Soviet biological weapons program in the former U.S.S.R. Moscow fears that bioweapons might be smuggled to terrorists through the ex-Soviet republics.

The public health field has undergone changes and modifications as a result of the rise in terrorist attacks. The threat of bioterrorism has encouraged countries to develop new emergency infrastructure in order to better coordinate functions and information that would be necessary in case of an attack. Cooperation on the prevention of bioterrorism on a global level would be an effective step towards averting the suffering that could be caused by a terrorist attack.

Strategies to effectively combat bioterrorism could include developing infrastructure and systems, which could detect and prevent through effective surveillance. It is important to train good specialists, who could analyze and track down chemical agents in contaminated areas to immediately avert or alleviate a problem, if an incident takes place.

It is necessary to understand how to respond to a potential bioterrorist attack, how to evacuate the population and what priorities should come first. Finally, special medical training and education should be available for people: They should know how to behave in the case of a biological attack. In this realm, Russia and the U.S. could find many opportunities to cooperate.

Infectious diseases

Infectious diseases are one of the greatest global challenges in medicine in our time. For centuries, infectious diseases have ranked with wars and famine as major challenges to human progress and survival. They remain among the leading causes of death and disability worldwide. In today’s global society, infectious disease outbreaks can spread quickly across the world, fueled by the rapidity with which we travel across borders and continents, as the Ebola outbreak of 2014-2015 demonstrated.

The epidemic went beyond Africa, with the cases of Ebola infection detected in the U.S., Spain, Italy, Great Britain and Mali. For this time, about 29 thousand people contracted Ebola, with about 11 thousand killed by the disease. Globalization aggravates the problem: if such an epidemic took place in a big Russian or American city, the death toll might be higher, because Moscow and Washington are not ready to respond to Ebola immediately.

The HIV-AIDS epidemic presents another major challenge. There are approximately 36.7 million people currently living with HIV globally and about two million people have died of AIDS-related causes in 2016, according to the World Health Organization.

In Russia, HIV-AIDS problem has become large-scale. According to statistics, for the first six months of 2017 about 80 people died of AIDS every day (to compare: about 50 people died in 2016). By the end of 2017, there were more 900 thousand of people living with HIV in Russia.

In the U.S. the situation is improving, yet the problem remains unresolved: 2015 had seen a 5% decrease in the cases of getting HIV since 2011, with almost 40 thousand Americans having been infected with it.

Fight against drug trafficking

Both the U.S. and Russia face a major problem with drug addiction. This issue poses a threat to the national security of both countries. About 18 million Russians have had some experience with drugs, while 8 million use drugs regularly. 70 thousand people have died from addiction, according to the 2016 data of Russia’s Federal Drug Control Service (FSKN). Its Director Viktor Ivanov predicts that the number of drug users might increase by 10 percent (800 thousand) in the future because of the economic crisis.

Likewise, the U.S. is faced with a new wave of drug addiction. In October 2017, U.S. President Donald Trump declared a public health emergency in response to the “national shame and human tragedy” of the U.S.’s increasing opioid epidemic. According to Centers for Disease Control and Prevention (CDC), “drug overdose deaths and opioid-involved deaths continue to increase in the United States”.

“The majority of drug overdose deaths (66%) involve an opioid. In 2016, the number of overdose deaths involving opioids (including prescription opioids and heroin) was 5 times higher than in 1999. From 2000 to 2016, more than 600,000 people died from drug overdoses. On average, 115 Americans die every day from an opioid overdose,” reads the CDC website.

Globally, about 158-351 million people are using drugs, while almost 30 million people are suffering from a grave drug addiction, according to a UN report.

The problem is international and is fuelled by drug trafficking from Afghanistan — a country notorious for its poppy production.

For Russia, which has the world’s highest number of heroin addicts per capita, the drug trade originates in Afghanistan and then travels through post-Soviet Central Asia before reaching Russia, and eventually Europe. One ex-Soviet republic in particular – Tajikistan – has been at the frontline of the worldwide campaign against the illegal drug trade and both Moscow and Washington have worked with the Tajik authorities to stop the spread of drugs through Eurasia.

In the case of the U.S., the drug trade travels from Central and South America through Mexico, and into the country’s Southwest.

Although the drug issue is often focused on preventing the flow of drugs and is framed in national security terms, it also poses considerable challenges for public health and drug rehabilitation. In this sphere, both Russia and the U.S. have much to gain through mutual cooperation.

Armed conflicts

From Yemen to Ukraine, armed conflict remains a major international challenge to public health. Such wars destroy important infrastructure, pollute the environment with weapon blasts, disrupt access to both water supplies and crucial medical care. Most importantly, they have provoked the current refugee crisis. The number of refugees from the Middle East is growing. According to the UN data, more than 5.4 million of people have left Syria since 2011, while over 13 million people urgently need help.

In addition to obvious physical injuries caused by conventional weapons, there is also a great need for treatment of psychological trauma and Post-Traumatic Stress Syndrome (PTSD).

International organizations, such as the Red Cross and Médecins Sans Frontières, have braved the conflict zones of Syria and Sudan to provide much-needed assistance to victims of war. However, it is not enough. The U.S. and Russia must work together toward ending conventional armed conflicts and mitigating their disastrous impact.

Climate change

The global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to contribute to the worldwide burden of disease and premature deaths. Scientists predict that rising average temperatures in some regions will change the transmission dynamics and geographic range of cholera, malaria, dengue fever, and tick-borne diseases.

A number of diseases—such as malaria, dengue fever, and viral encephalitis infections—are highly sensitive to changes in the environment. The West Nile virus emerged in the Eastern U.S. in 1999, during the hottest and driest summer in a century. Subsequent outbreaks in the Midwestern U.S. also coincided with heat waves. Scientists believe that hot weather may speed up both the breeding cycle of mosquitoes and replication of the virus inside the insects.

The threat of infectious diseases is even greater in Africa, where a child dies every two minutes, before the age of five. In 2016, about 200 million of Africans contracted malaria. Every year 500 people die from it, and more than three billion are living in a risk zone. Efforts to mitigate the impact of global warming and stop the spread of such diseases must be addressed by global cooperation involving Washington and Moscow.

Nuclear crisis

Nuclear weapons have a potentially devastating impact on the surrounding environment and consequently on public health. Currently, Russia and the United States possess the largest stockpiles of nuclear weapons in the world, with the former holding 7,500 weapons and the latter 7,200.

Experts, such as former Pentagon chief William Perry, have stated that the current confrontation between Washington and Moscow is even more dangerous now than during the Cold War.

On Jan. 25, the Bulletin of the Atomic Scientists set the hand of the Doomsday Clock to two minutes to midnight and called on the U.S. and Russia to engage in talks to avoid nuclear conflict. It is imperative that the two powers work not only toward nuclear nonproliferation, but also nuclear disarmament. This is a global challenge that needs a global response.

Pietro A. Shakarian is a PhD candidate in History at The Ohio State University in Columbus, focusing on Russia, Eurasia and Caucasus. He earned his MA in Russian, East European, and Eurasian Studies at the University of Michigan in Ann Arbor, his MLIS at Kent State University, and his BA in History at John Carroll University in Cleveland.

Lusine Gigoyan is a student in the Master of Public Health program at Kent State University. She earned her BA in Management at Yerevan State University in Yerevan, Armenia.